1699829580 NPI number — CAROL MADISON GLOVER M.D.

Table of content: CAROL MADISON GLOVER M.D. (NPI 1699829580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699829580 NPI number — CAROL MADISON GLOVER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLOVER
Provider First Name:
CAROL
Provider Middle Name:
MADISON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699829580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 PIEDMONT RD NE
Provider Second Line Business Mailing Address:
NINE PIEDMONT CENTER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-364-7070
Provider Business Mailing Address Fax Number:
770-422-2049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 TOWNPARK LN NW
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE TOWN PARK MEDICAL CENTER
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-5579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-365-0966
Provider Business Practice Location Address Fax Number:
770-422-2049
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  028987 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00808948 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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